The Yin and Yang of 2016: A Crisis Year Holds Promise

There is urgent need for widespread and early education of the medical profession, legislators, administrative authorities and the general public into the facts of substance use conditions. Until opiate addiction is widely appreciated and taught as a definite disease, and treatment is provided…we cannot hope for intelligent handling of the opiate problem, nor for the solution of the national drug problem.

Dr. Ernest Bishop, American Journal of Public Health, July 1919

Almost a century has passed, but these words continue to ring true and speak to our current tragic opiate crisis. This crisis has touched almost everyone I have met and has spared no demographic group. The silver lining in this cloudy sky is the mobilization and alignment of legislators, medical professionals, the public and the insurance industry on wiping out this epidemic. Fortunately, changes have occurred rapidly that foretell a positive direction.

The silver lining in this cloudy sky is the mobilization and alignment of legislators, medical professionals, the public and the insurance industry on wiping out this epidemic.

Consider the significant accomplishments in 2016:

The passage and hopeful funding of the Comprehensive Addiction and Recovery Act in July 2016, which supports the expansion of diversion programs; the expanded provision of buprenorphine, methadone and other forms of medication-assisted treatment (MAT); and the expanded use of naloxone by first responders and community members.

In November, the Department of Health and Human Services took steps to expand the use of MAT by allowing a significant increase in provider access and expansion of prescription privileges to prescribe buprenorphine starting in January 2017.

The American Board of Medical Specialties officially recognized Addiction Medicine as a subspecialty in March of 2016.

The November Surgeon General’s report “Facing Addiction in America” is the nation’s first comprehensive report on the state of substance use disorders (SUD) in this country. The report reinforces the potential harmful effects and dangers of substance use in a similar manner as the Surgeon General’s seminal report on the risks of smoking. The use of opiates is no longer considered safe and without risk for treatment of pain. Among its highlights is the statement that addiction is a chronic neurological disease, and not a moral failing, and should be treated as such in line with other major chronic conditions.

The push for community-based care

In summary, 2016 was a big year. These policy-based changes drive us to break the stigma around SUD by officially acknowledging it as a chronic condition. However, with funding comes the responsibility of appropriately allocating resources. We don’t want to repeat past errors regarding the stigmatization of mental health, which contributed to funding for long-term hospital institutions where many individuals with psychiatric conditions were marginalized. We have since learned that less restrictive, community-based care is most effective because it supports a chronic disease model of care – a model that reaches people faster, providing treatment and support services locally. Put differently, people recover better where they live, and people don’t live in hospitals.

We have learned a lot, but we have further to go. Our utmost challenge is creating community evidence-based outpatient programs that dovetail with the development of vocational skills and safe housing – a trigger-free environment – for the best chance at promoting recovery. To that end, we also need to help communities and educational institutions create supportive recovery “zones” or activities.

These policy-based changes drive us to break the stigma around SUD by officially acknowledging it as a chronic condition. However, with funding comes the responsibility of appropriately allocating resources.

I hope that looking back, 2016 will be seen as the turning point in accepting substance use as a non-stigmatized treatable condition. I hope it’s the year that drives community-based systems of care to become the norm, not the exception. I trust 100 years from now the quote above from 1919 will not resonate. We owe this to those who have been lost to this treatable condition and their families and loved ones.